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Broken Orthopaedic Implant: An Experience at PIMS |
Ali Akhtar* |
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Objective: To determine the causes of broken implants which are being used locally for fixation of different fractures.
Study Design: Case series study. Place and Duration: This study was conducted at the Department of Orthopaedic Surgery, Pakistan Institute of Medical Sciences (PIMS) from May 2, 2006 to April 30, 2009. Materials and Methods: The study included adult patients of either gender, reporting to the O.P.D. of Orthopaedic Surgery, with complaint of pain, deformity and loss of function after open reduction and internal fixation or external fixation of either limb. Results: Out of thirty nine patients, 35 were males and 4 were females. They presented with broken dynamic compression plates, interlocking nails, K-nails, rush nails and Schanz screws. Conclusion: The most important cause of implant breakage is its quality. Orthopaedic implants, either nails or plates when used for fracture fixation, act as weight sharing or weight bearing implants and are exposed to tremendous stress till the fracture unites. Quality of the implants should not be compromised and strict adherence to surgical principles should be ensured. Key Words: Broken implants. Open reduction and internal fixation. IntroductionThe main objective of the treatment of the fractured bones is that the bone should heal in such position that the function and cosmesis of the limb is not compromised. Generally, the methods of definitive treatment are conservative and operative. Most of the time, the end result of the conservative method is joint stiffness, soft tissue atrophy, osteoporosis and chronic oedema of the limb. To address these problems, open reduction and internal fixation was the break through in the history of fracture management when used in 1886. Later on, in 1970, Lane used plates and screws which were ordinary steel made but the problem was metallic corrosion, loosening, breaking of implants and chronic inflammation. 1-3 Significant developments have been taking place to provide suitable biomaterials from metals/ alloys, ceramics bio-glasses, and polymers with minimal reaction and rejection by body. 4-6 The most dramatic innovation in the internal fixation was development of a system of rigid fixation with plates and screws by the A O / ASIF group. 7, 8 Their objective has been to make the fracture fixation so stable that immediately after the operation patient can do active exercises of muscles and joint. They have been able to address the problems related to conservative treatment. Metals were found as material of choice for implant manufacturing because they offer high stiffness, strength, good ductility and good biocompatibility. To achieve this aim along with innovation in the techniques of application of implants, the special emphasis was on the improvement of metallurgy of the implants to avoid problems faced with use of ordinary steel made implants. 9 Apart from metals, ceramics, titanium, titanium alloys, polymers carbon composites and degradable materials are being used for different implants and prosthesis. 10 The present study was undertaken to determine the causes of broken implants which are being used locally for the fixation of different fractures.
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